suture patterns

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Last updated 1:44 AM on 10/16/26
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16 Terms

1
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appositional pattern characteristics

  • tissue effect: brings two cut surfaces of the tissue into direct approximation

  • common uses: for anatomically precise closure


2
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inverting pattern characteristics

  • tissue effect: turn tissue edges inward

  • common uses:

    • enclose a contaminated edge

    • for fascial imbrication


3
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everting pattern characteristics

  • tissue effect: turn tissue edges outward

  • common uses:

    • eliminate dead space

    • counteract tendency of wound edges to invert during healing


4
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tension-relieving pattern characteristics

  • tissue effect: redistribute the tension across the wound edges

    • draw wound edges together while minimizing marginal strangulation and necrosis

  • common uses:

    • wounds

    • following mass removal

    • skin closure over implants


5
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simple interrupted

appositional

  • excessive tension when tied may cause inversion


6
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cruciate pattern

  • appositional

  • advantages:

    • stronger closure than simple intrrupted

    • increased efficiency

      • gains more space per suture than SI

    • mild tension relief


<ul><li><p><strong>appositional</strong></p></li><li><p>advantages:</p><ul><li><p>stronger closure than simple intrrupted</p></li><li><p>increased efficiency</p><ul><li><p>gains more space per suture than SI</p></li></ul></li><li><p>mild tension relief</p></li></ul></li></ul><p></p>
7
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interrupted vertical mattress (IVM)

  • tension-relieving

  • appositional to everting

  • advantages

    • stronger under tension than SI

    • less interference with vascular supply than other mattresses


<ul><li><p>tension-relieving</p></li><li><p><strong>appositional to everting</strong></p></li><li><p>advantages</p><ul><li><p>stronger under tension than SI</p></li><li><p>less interference with vascular supply than other mattresses</p></li></ul></li></ul><p></p>
8
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interrupted horizontal mattress (IHM)

  • tension-relieving

  • everting

    • degree depends on suture tension & distance to wound margin

    • more everting than vertical mattress

  • comparison to IVM

    • distributes tension over wider area

    • weaker under tension

    • higher potential for tissue strangulation / interference with blood supply


<ul><li><p>tension-relieving</p></li><li><p><strong>everting</strong></p><ul><li><p>degree depends on suture tension &amp; distance to wound margin</p></li><li><p>more everting than vertical mattress</p></li></ul></li><li><p>comparison to IVM</p><ul><li><p>distributes tension over wider area</p></li><li><p>weaker under tension</p></li><li><p>higher potential for tissue strangulation / interference with blood supply</p></li></ul></li></ul><p></p>
9
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near-far-far-near

  • far component: tension relief

  • near component: apposition

  • advantages / disadvantages

    • higher resistance to tension

    • more suture material in the wound than other patterns


<ul><li><p>far component: tension relief</p></li><li><p>near component: apposition</p></li><li><p>advantages / disadvantages</p><ul><li><p>higher resistance to tension</p></li><li><p>more suture material in the wound than other patterns</p></li></ul></li></ul><p></p>
10
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simple continuous

  • maximal tissue apposition

  • advantages / disadvantages

    • time/material saving

    • relatively air / fluid tight closure

    • excessive tension can cause strangulation of wound edge

    • anatomically less precise than SI pattern


11
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ford interlocking

  • continuous pattern where each loop is locked by the succeeding pass

  • appositional

  • advantages / disadvantages

    • precise adaptation

    • greater security in the event of a partial failure

    • may be difficult to remove

    • may cause pressure necrosis & become buried when placed under tension


<ul><li><p>continuous pattern where each loop is locked by the succeeding pass</p></li><li><p><strong>appositional</strong></p></li><li><p>advantages / disadvantages</p><ul><li><p>precise adaptation</p></li><li><p>greater security in the event of a partial failure</p></li><li><p>may be difficult to remove</p></li><li><p>may cause pressure necrosis &amp; become buried when placed under tension</p></li></ul></li></ul><p></p>
12
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intradermal pattern

  • appositional

  • advantages / disadvantages

    • superior cosmetic outcome

    • no need for suture removal

    • provides less strength than percutaneous skin closure


13
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cushing pattern

  • inverting

  • formed by taking a bite parallel to incision before crossing the incision to repeat

    • bites go into the submucosa

    • do NOT enter the lumen

  • used for closure of hollow viscera

    • results in watertight seal

  • advantage

    • less luminal reduction than Lembert pattern


<ul><li><p><strong>inverting</strong></p></li><li><p>formed by taking a bite parallel to incision before crossing the incision to repeat</p><ul><li><p>bites go into the submucosa</p></li><li><p><strong><u>do NOT enter the lumen</u></strong></p></li></ul></li></ul><ul><li><p><strong>used for closure of hollow viscera</strong></p><ul><li><p>results in watertight seal</p></li></ul></li><li><p>advantage</p><ul><li><p>less luminal reduction than Lembert pattern</p></li></ul></li></ul><p></p>
14
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utrecht pattern

  • modified cushing pattern

  • inverting

  • bites are taken diagonally rather than parallel to line of incision

  • most commonly used to close ruminant uteruses


<ul><li><p>modified cushing pattern</p></li><li><p><strong>inverting</strong></p></li><li><p>bites are taken diagonally rather than parallel to line of incision</p></li><li><p>most commonly used to close ruminant uteruses</p></li></ul><p></p>
15
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connell pattern

  • similar to cushing pattern BUT

    • bites penetrate all layers of bowel

    • DO enter lumen

  • inverting

  • disadvantages

    • subject to wicking of visceral contents


<ul><li><p>similar to cushing pattern BUT</p><ul><li><p>bites penetrate all layers of bowel</p></li><li><p><strong><u>DO enter lumen</u></strong></p></li></ul></li><li><p><strong>inverting</strong></p></li><li><p>disadvantages</p><ul><li><p>subject to wicking of visceral contents</p></li></ul></li></ul><p></p>
16
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lembert pattern

  • wide bite & exiting near to incision on one side before crossing incision to take near-to-far bite on other side

    • bites penetrate submucosa

    • do NOT penetrate lumen

  • can result in considerable inversion

    • edges can continuously roll more and more inward if not careful when taking bites

  • can be used for imbrication procedures


<ul><li><p>wide bite &amp; exiting near to incision on one side before crossing incision to take near-to-far bite on other side</p><ul><li><p>bites penetrate submucosa</p></li><li><p><strong><u>do NOT penetrate lumen</u></strong></p></li></ul></li><li><p>can result in considerable <strong>inversion</strong></p><ul><li><p>edges can continuously roll more and more inward if not careful when taking bites</p></li></ul></li><li><p>can be used for imbrication procedures</p></li></ul><p></p>